The Grizzly, November 29, 2007

Goodbye Scripted TV: Writer\u27s Guild Takes a Stand • Shooting for the Cure: Teams Raise Money for Coalition • Dr. von Schlegell Discusses Islamic Thought, Movements • Jazzman\u27s Cafe Gets Into the Holiday Spirit at Ursinus • A New STAR on Campus • Moritomo: Konichiwa, Hai Hai! • Focus the Nation: Cornucopia of Action and Awareness • Book Review: A Natural History of the Senses • Opinions: Giving Thanks This Holiday; UN Considers Ban on Human Cloning • Field Hockey Frenzy • Men\u27s Basketball Preview • Bears Take the Path Less Traveledhttps://digitalcommons.ursinus.edu/grizzlynews/1751/thumbnail.jp

The Grizzly, October 11, 2007

Up \u27til Dawn Beats the Yawn to Fight Against Childhood Cancer • The Voice of WHYY Speaks at Myrin Library\u27s First Friday Series • WeCAN Focuses on Workers\u27 Rights • Omega Chi Hosts Annual Campus Blood Drive • Sexual Health in the Heat: Philly OutFest • UC Theater Presents Gilgamesh • Water Bottles: Robbing Our Environment and Our Homes • Book Review: Extremely Loud and Incredibly Close • Opinions: CIE Students, Are You Listening?; Live Earth: Retrospective; No Thank You, UC Meal Plan • No Pads, No Guards, No Problemshttps://digitalcommons.ursinus.edu/grizzlynews/1746/thumbnail.jp

The Grizzly, September 6, 2007

The Car Share Revolution • Ursinus Initiates Film Fest • Facilities Makes Renovation Waves • Stopping the Stork: Emergency Contraception • A Look at The Rising Suns • Spotlight on Sustain UC • Book Review: What is What by Dave Eggers • Opinions: With Gonzales\u27 Resignation, Exodus Continues; Harry Potter and the Satanic Pre-Teens; Don\u27t Paint Over Our Freedom of Expression • Intramural Intervention • Field Hockey Flavor • Football Sets the Bar High with 28-0 Rout of LaSalle • Fight for the Tophttps://digitalcommons.ursinus.edu/grizzlynews/1741/thumbnail.jp

The Grizzly, September 27, 2007

Going Green: Ursinus Commits to Improving Energy Efficiency • Ursinus Joins Fight Against U.K. Boycott • Grad School Guru Advises UC Seniors • Popping the Pill Continued: DRSP • Hillel and Muslim Student Association Host Break-Fast • Faculty Spotlight: Barbara von Schlegell • Book Review: Vain Art of the Fugue by Dumitru Tsepeneag • Opinions: Ursinus Goes (Not So) Silent for Jena 6; The Arctic Isn\u27t as Neutral Anymore • Superstitions • UC Hosting \u2707 Field Hockey NCAA Championship • Welcome to the Family: UCXChttps://digitalcommons.ursinus.edu/grizzlynews/1744/thumbnail.jp

The Grizzly, November 8, 2007

Campus Safety Offers Tips to Stay Alert, Aware • Lost Boy Speaks on Civil War in Sudan, Genocide in Darfur • Car for a Cause Pulls Into Ursinus • UC Democrats Kick Off Montgomery County Campaign Invasion • If Nobody Speaks of Remarkable Things • Darfur Fast • Entrance Fee: Five Packs of Cigarettes • Opinions: Forgotten Promise: Iraq\u27s Refugees • Spotlight: Coach Kyle Rush • Bears Fall to Muleshttps://digitalcommons.ursinus.edu/grizzlynews/1749/thumbnail.jp

Comparison of different late gadolinium enhancement techniques in various cardiac diseases using cardiovascular magnetic resonance imaging

Hintergrund: Die kardiovaskuläre Magnetresonanztomographie (CMR) ist ein etabliertes diagnostisches Verfahren für kardiovaskuläre Erkrankungen. Sequenzen mit später Kontrastmittelanreicherung (Late Gadolinium Enhancement, LGE) erlauben eine genaue Gewebedifferenzierung bezüglich myokardialer Fibrosen. Das Vorhandensein auch kleiner Narben- bzw. Fibrosenareale korreliert dabei mit einer erhöhten Morbidität und Mortalität. Eine genaue Detektion von LGE ist daher für die Risikostratifizierung und Therapieplanung kardialer Erkrankungen essentiell. In dieser Arbeit werden verschiedene multi-slice LGE-Sequenzen mit einer segmentierten LGE-Sequenz verglichen. Hierfür wurden Patienten mit ischämischen und nicht-ischämischen kardialen Erkrankungen ausgewählt, namentlich koronare Herzkrankheit (KHK), hypertrophe Kardiomyopathie (HCM) bzw. linksventrikuläre Hypertrophie (LVH) und Myokarditis. Methoden: Es wurden insgesamt 328 Patienten in eine prospektive klinische Studie eingeschlossen. Alle Untersuchungen wurden an einem 1,5 Tesla MRT-Gerät durchgeführt. Mindestens sieben Minuten nach Gabe eines Gadolinium-haltigen Kontrastmittels in gewichtsadaptierter Dosis (0,2 mmol/kg) wurden drei LGE-Sequenzen in randomisierter Reihenfolge akquiriert: eine segmentierte fast low-angle shot (FLASH) phase-sensitive inversion recovery (PSIR) Sequenz in sog. Single-Slice/Single- Breath-Hold-Technik als Referenzstandard, eine multi-slice steady-state free precession (SSFP)-IR-Sequenz in Atemanhalte sowie eine multi-slice SSFP-PSIR- Sequenz sowohl in Atemanhalte (bh) als auch in freier Atmung (nonbh). Die Bilddaten wurden hinsichtlich qualitativen (Bildqualität, Signal- und Contrast-to- Noise-Ratio) und quantitativen Parametern (LGE-Massen, Akquisitionszeiten) ausgewertet. Ergebnisse: Die endgültige Stichprobengröße umfasste 298 Patienten (n=203 KHK, n=50 HCM/LVH, n=45 Myokarditis). Bei insgesamt 247 der Patienten wurde in der Referenzsequenz positives LGE detektiert (176 der KHK-Patienten, 39 der HCM/LVH- Patienten und 32 der Myokarditis-Patienten). Die mittlere detektierte LGE-Masse betrug in der FLASH-PSIR 8,96±10,64 g. Der Vergleich der multi-slice Sequenzen erbrachte gegenüber dem Referenzstandard keine signifikanten Unterschiede (SSFP- IR 8,69±10,75 g vs. SSFP-PSIR bh 9,05±10,84 g vs. SSFP-PSIR nonbh 8,85±10,71 g). Die höchsten Werte bei Bildqualität (1,38±0,59) und Contrast-to-Noise-Ratio (137,8±103,7) wurden jeweils von der SSFP-PSIR-Sequenz erzielt. Die Akquisitionszeiten waren bei allen multi-slice Sequenzen signifikant kürzer im Vergleich zum Referenzstandard (FLASH-PSIR 361,52±95,33 s vs. SSFP-IR 23,36±7,15 s vs. SSFP-PSIR bh 21,95±6,42 s vs. SSFP-PSIR nonbh 21,62±5,52 s). Das Vorhandensein von Arrhythmien oder eine freie Atmung bei den multi-slice Sequenzen zeigte keinen Einfluss auf die detektierte LGE-Masse. Zusammenfassung: Diese Studie konnte zeigen, dass die getesteten multi-slice LGE-Sequenzen äquivalent zur bisher verwendeten segmentierten Referenzstandard-Sequenz sind, unabhängig von einer ischämischen oder nicht-ischämischen Genese der Narben/Fibrosen. Die multi-slice Sequenzen sind aufgrund der erzielten Ergebnisse eine gute Alternative zur etablierten FLASH-PSIR-Sequenz, insbesondere auch bei arrhythmischen Patienten oder Patienten, die zu suffizienten Atemanhalten nicht in der Lage sind. Außerdem kann durch die Zeitersparnis der multi-slice Sequenzen die Effizienz von CMR-Untersuchungen gesteigert werden.Background: Cardiovascular magnetic resonance imaging (MRI) is an established diagnostic method for cardiovascular diseases. Especially sequences based on late gadolinium enhancement (LGE) provide good differentiation of myocardial fibrosis. Even small lesions of fibrotic myocardium predict higher morbidity and mortality. Therefore an accurate detection of LGE is necessary for risk stratification and therapy of cardiovascular diseases. This study compares three different multi-slice LGE sequences to the segmented reference standard method in patients with underlying ischemic and non-ischemic cardiovascular diseases: coronary artery disease (CAD), hypertrophic cardiomyopathy (HCM) as well as left ventricular hypertrophy (LVH) and myocarditis. Methods: 328 patients were prospectively enrolled. All scans were performed at 1.5 Tesla MRI. At least seven minutes after administration of gadolinium-based contrast agent in weight-adopted dose (0.2 mmol/kg) three LGE sequences were acquired in a randomized order: a segmented fast low-angle shot (FLASH) phase-sensitive inversion recovery (PSIR) sequence in single-slice/single-breath-hold technique which served as reference standard, a multi-slice steady-state free precession (SSFP)-IR sequence with one breath hold and a multi-slice SSFP-PSIR sequence both with one breath hold (bh) and while free breathing (nonbh). The images were analyzed regarding qualitative (signal and contrast to noise ratio, image quality) and quantitative parameters (LGE mass, acquisition time). Results: The data of 298 patients were analyzed for the study (n=203 CAD, n=50 HCM/LVH, n=45 myocarditis). 247 patients had detectable LGE in the reference standard sequence (176 patients with CAD, 39 patients with HCM/LVH and 32 patients with myocarditis, respectively). Mean detected LGE mass was 8,96±10,64 g in FLASH- PSIR. Multi-slice sequences showed no significant differences to the reference standard (SSFP-IR 8.69±10.75 g vs. SSFP-PSIR bh 9.05±10.84 g vs. SSFP-PSIR nonbh 8.85±10.71 g). Highest image quality (1.38±0.59) and contrast to noise ratio (137.8±103.7) were detected in SSFP-PSIR. Acquisition times were significantly shorter in all multi-slice sequences compared to reference standard (FLASH-PSIR 361.52±95.33 s vs. SSFP-IR 23.36±7.15 s vs. SSFP-PSIR bh 21.95±6.42 s vs. SSFP-PSIR nonbh 21.62±5.52 s). Mean LGE mass was not affected by presence of arrhythmias or by free breathing on multi-slice sequences. Conclusions: This study showed equivalence between tested multi-slice LGE sequences and segmented reference standard, independent from ischemic or non-ischemic cause of myocardial fibrosis. Due to obtained results, the tested multi-slice sequences represent a possible alternative to established segmented FLASH-PSIR, especially in patients with arrhythmias or insufficient breath hold capacity. Moreover the efficiency of cardiovascular MRI can be increased due to shorter acquisition times of multi-slice sequences

Comparison of fast multi-slice and standard segmented techniques for detection of late gadolinium enhancement in ischemic and non-ischemic cardiomyopathy – a prospective clinical cardiovascular magnetic resonance trial

Abstract Background Segmented phase-sensitive inversion recovery (PSIR) cardiovascular magnetic resonance (CMR) sequences are reference standard for non-invasive evaluation of myocardial fibrosis using late gadolinium enhancement (LGE). Several multi-slice LGE sequences have been introduced for faster acquisition in patients with arrhythmia and insufficient breathhold capability. The aim of this study was to assess the accuracy of several multi-slice LGE sequences to detect and quantify myocardial fibrosis in patients with ischemic and non-ischemic myocardial disease. Methods Patients with known or suspected LGE due to chronic infarction, inflammatory myocardial disease and hypertrophic cardiomyopathy (HCM) were prospectively recruited. LGE images were acquired 10–20 min after administration of 0.2 mmol/kg gadolinium-based contrast agent. Three different LGE sequences were acquired: a segmented, single-slice/single-breath-hold fast low angle shot PSIR sequence (FLASH-PSIR), a multi-slice balanced steady-state free precession inversion recovery sequence (bSSFP-IR) and a multi-slice bSSFP-PSIR sequence during breathhold and free breathing. Image quality was evaluated with a 4-point scoring system. Contrast-to-noise ratios (CNR) and acquisition time were evaluated. LGE was quantitatively assessed using a semi-automated threshold method. Differences in size of fibrosis were analyzed using Bland-Altman analysis. Results Three hundred twelve patients were enrolled (n = 212 chronic infarction, n = 47 inflammatory myocardial disease, n = 53 HCM) Of which 201 patients (67,4%) had detectable LGE (n = 143 with chronic infarction, n = 27 with inflammatory heart disease and n = 31 with HCM). Image quality and CNR were best on multi-slice bSSFP-PSIR. Acquisition times were significantly shorter for all multi-slice sequences (bSSFP-IR: 23.4 ± 7.2 s; bSSFP-PSIR: 21.9 ± 6.4 s) as compared to FLASH-PSIR (361.5 ± 95.33 s). There was no significant difference of mean LGE size for all sequences in all study groups (FLASH-PSIR: 8.96 ± 10.64 g; bSSFP-IR: 8.69 ± 10.75 g; bSSFP-PSIR: 9.05 ± 10.84 g; bSSFP-PSIR free breathing: 8.85 ± 10.71 g, p > 0.05). LGE size was not affected by arrhythmia or absence of breathhold on multi-slice LGE sequences. Conclusions Fast multi-slice and standard segmented LGE sequences are equivalent techniques for the assessment of myocardial fibrosis, independent of an ischemic or non-ischemic etiology. Even in patients with arrhythmia and insufficient breathhold capability, multi-slice sequences yield excellent image quality at significantly reduced scan time and may be used as standard LGE approach. Trial registration ISRCTN48802295 (retrospectively registered)